What did you expect? The need for healthcare leaders to better manage our own expectations and those of our staff, doctors and patients

On most days we derive great satisfaction from our careers as practice managers. There are also days which seriously challenge our management skills.

• “I can’t believe you people know what you’re doing! I can’t spend all day here — my time is valuable, too,” a patient yelled to an embarrassed front desk worker as he stormed out of the office, livid.
• “I’m sorry, Sally, but I’m afraid we’re going to have to let you go,” the manager calmly stated to the young woman, tears welling up in her eyes. “You just can’t get to work when we need you.”
• The manager, frustrated and somewhat uncomfortable, approached the doctor. “Doctor Smith, we just rescheduled those patients for the third time. We really do need more notice when you want time off. Patients are leaving your practice.”

 
These unfortunate scenarios are not uncommon in doctors’ offices. All share three common characteristics: 

1. They are the unfortunate result of a failure to meet someone’s expectations 
2. They are expensive for a practice 
3. They are likely avoidable.

 
These and similar incidents occur all too often because almost every problem in our practices is the result of a failure of someone or something to meet someone else’s expectations. We don’t meet the patients’ expectations. The staff doesn’t meet your expectations. Someone lets someone else down. The computer we expected to run properly breaks down.

Failure to meet expectations is a common thread in work problems and problems throughout life. Each day, people file for divorce. People are inconvenienced or injured because cars, computers and other equipment break down. Even when we get sick, it is the failure of our body to meet our expectations. We didn’t expect to get sick then and now expect the “system” to get us better. These external failures affect your employees even before they show up for work.

Recognizing this common link can help you avoid and resolve future problems. Management of expectations (MOE) is an essential skill a practice manager must develop to have a successful career. We must better understand our own expectations and strive to convey those expectations more clearly. We must strive to understand others’ expectations (e.g., doctors, staff and patients) and help them to understand if their expectations are reasonable and being clearly conveyed.

Success in meeting the expectations of your patients, doctors and staff is achieved by managing expectations, which involves communicating, molding and understanding expectations. The likelihood of staff meeting your expectations probably relies more on you than on them.

Let’s explore why expectations are not met and how we can increase the likelihood of meeting them.

1. Vague expectations

We may not clearly know the expectations of our doctors, staff or patients. A manager must be careful not to project assumed expectations. Ask your doctors and staff to write down their goals, objectives and priorities. Survey patients to determine what is important to them — what do they really expect when they come to your practice?

As managers, we generally know what we want, but we don’t necessarily communicate those expectations to others clearly. The first problem with expectations occurs, however, if we don’t know what we want. If we haven’t set our goals, objectives and priorities, we cannot clearly convey our expectations to others. Mission statements, goals, objectives and priorities should be clear and specific. This is not just an exercise, but a necessary first step in assuring that our expectations can be attained. Written expectations take many forms: They may be job descriptions, HR handbooks, contracts, request for proposals (RFP), or policies and procedures.

2. Unrealistic expectations 

Could I or our doctors have unrealistic expectations? There’s a fine line between goals that stretch us and unrealistic expectations. Not knowing the difference can produce frustration and failure. Testing one’s assumptions is crucial. What are some common erroneous assumptions? 

• Assuming an unqualified person can do a job without significant training and supervision 
• Assuming a new computer system will do everything you thought you heard the salesperson say 
• Assuming you understand what is most important to your patients, staff and doctors.

 
To test your assumptions, spend time on the front end to determine if your expectations are realistic based upon your assumptions. Consider the job applicant example: Our assumption is that if we hire this applicant, he or she will perform the job to our satisfaction. How can we best assure our assumption is valid? 

• Step 1. Determine what qualifications are necessary to successfully accomplish the tasks and write down your expectations and the qualifications (job description). 
• Step 2. Determine the extent of an applicant’s qualifications (interview and testing). 
• Step 3. Share your expectations for the applicant’s job performance and elicit the applicant’s understanding and commitment to your expectations. (This third step is frequently omitted.) 
• Step 4. Determine what additional support (training, monitoring or equipment) the applicant might need to better ensure their success. 
• Step 5. Determine if you are willing to commit the resources necessary to ensure that applicant’s success.

 
How about that computer selection? An RFP should detail your specific requirements for a computer system. A good RFP is very time consuming to develop; however, there is no better way to clearly list and describe your precise expectations for a computer system. If the chosen vendor commits in writing to meet the expectations you have detailed in an RFP, you’ve taken a significant step to ensure your expectations will be met by the selected system.

What if you believe your doctors’ expectations are unrealistic? If so, you should discuss this with your doctors upfront. Otherwise, you may well face a doctor’s displeasure later when you fail to meet her or his expectations. 

Increasing the likelihood that your expectations will be met is not a matter of luck. It is hard work — and a matter of managing expectations.

3. Miscommunicated expectations

Possibly the most common cause in the failure to meet expectations is in the failure to communicate clearly. We assume people understand our needs and wants once we’ve communicated the information. However, sometimes that information does not accurately or completely convey our desires, nor do we confirm comprehension. We know what we meant and assume the recipient of our desires does also. Effective communication usually requires feedback from the listener to acknowledge understanding; for example, asking questions of the recipient is an effective means to confirm understanding.

Conveying expectations only verbally allows much more opportunity for misunderstanding. Since written expectations don’t require memorization, you can substantially increase the probability that they will be effectively communicated, understood and taken seriously.

Expectations are more likely to be met with two-way communication. There’s a risk of not listening attentively if we focus attention on making our point and fall short in our listening skills. There is risk when we assume we already know the other person’s expectations or misperceive the other person’s expectations to be not as important as our own. 

The best salespeople know the secret: Don’t push your product or service; rather, ask questions to evaluate the needs of the buyer, then proceed to let the buyer know how your product or service satisfies their verbalized needs. If you don’t listen, you won’t hear their needs and expectations, and therefore cannot relate your expectations to theirs.

Surveys, focus groups and staff feedback are proven ways to elicit others’ opinions, needs and expectations. 

4. Conflicting expectations

Our expectations frequently bump up against someone else’s expectations. The patient expects to be seen promptly. The doctor expects worked-up patients in the room to avoid down time.

Humans are selfish creatures — we seek to satisfy our own comfort level. While there are a lot of well-intentioned people in the medical field, many of us entered the field to help people in need. Perhaps that is why many of us are so dismayed when our patients express their frustrations. 

Are our priorities clear? When there are conflicts, whose expectations take priority? Is it the patients’, the staff’s, or the doctors’? Discuss with your doctors the implications of whose expectations truly take priority and help them decide whose expectations will have priority. Apply those priorities to corporate and management decisions.

If we perceive people’s expectations and determine where they conflict with our own, we can create a plan to resolve the conflicts. Expectations can be created and changed, and we can help others reevaluate theirs.

What do you communicate to prospective patients about expected wait times or the length of a visit? When scheduling, let patients know how much time to allocate for the appointment. When the patient arrives, you know there will be a 20-minute wait — communicate this information upfront. You can even tell them it will be a 30-minute wait along with the amount of time they can expect to be in the office. Create an expectation you can meet or beat.

5. Not rewarding met expectations

I’m convinced that most employees want to please their boss. There are a few people who rebel against authority, but they are not representative of most employees. Be wary of failing to appropriately reward those who meet our expectations while continuing to reward those who do not meet our expectations.

Your staff will perform in accordance with what is most comfortable, provides maximum reward and avoids punishment. Financial incentives are very effective; however, they may not always produce the desired results. While they might work to motivate one group, it could be at the expense of de-motivating another group. Do your compensation plan, incentive bonuses and praise clearly reward those who meet your expectations? Do they also reward those who do not meet your expectations? A cost-of-living increase to everyone simply rewards tenure. 

Your expectations for staff performance should be written and discussed at the beginning of a performance period so that each person knows what is expected to receive a raise or a bonus.

A practical example of MOE

For many years I found that employees were being disciplined or terminated for not meeting our expectations. To proactively prevent this, I wrote down those expectations and presented them to job applicants. I asked them to read our expectations and sign the list if they understood our expectations and agreed to comply with them if hired. Most applicants signed, while a few simply left. When a work-related problem surfaced with a new employee, the root cause was inevitably on the list of expectations they had agreed to uphold. This made dealing with the problem much easier. If the person needed to be terminated, we inevitably won the unemployment compensation case since we had proof that the matter had been addressed before hiring.

These five steps will help you manage expectations:

1. Carefully critique and clarify your own assumptions and expectations.
2. Carefully convey (communicate) your expectations.
3. Listen to others and understand their expectations.
4. Relate your expectations in terms of others’ needs and expectations.
5. Reward only those who meet your expectations.

 
Your career growth and success as a practice manager depends on your ability to understand the expectations of your doctors; to formulate realistic and achievable expectations for yourself, your staff and your patients; to effectively communicate those expectations to those who must accomplish them; and to facilitate the accomplishment of those expectations through negotiation and appropriate rewards. Using the techniques outlined in this article will help you better convey and realize your expectations and increase the likelihood that your doctors, staff and patients will realize their expectations.